Fact-sheet: Dorsal dermal sinus
Updated on 07/14/2016 at 10:28 AM
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Definition
Epithelialized tract extending from a skin dimple to the spinal canal.
This is a closed spinal dysraphism: covered by skin
Clinical features
Small midline dimple +/- small angioma +/- soft tissue asymmetry
often associated with intraspinal lipomas, low tethered cord.
May be located at any level but sacrococcygeal ++
Possible CSF leakage when communicating
Risk of infectious, neurological, or orthopedic complications, which may also reveal it.
Recurrent meningitis or meningitis due to unusual organisms is a very common presenting feature in young children.
Various neurological signs, ranging from simple hyporeflexia to paraplegia, or to bladder-sphincter disorders. Signs generally subtle in young children (delayed acquisition of walking or continence).
Rare orthopedic abnormalities: clubfoot or equinovarus foot, limb length asymmetry, scoliosis.
Ultrasound
Straight hypoechoic tract,
CT
Examination not performed as first-line,
hypodense tract
MRI
T1-T2 hypointense tract
Management
Surgical management
Surgical complications are rare and justify performing surgery as early as possible in life.
Classification
Closed dysraphism: covered by intact skin * With subcutaneous mass 1-Lipomyelocele 2-Lipomyelomeningocele 3-Meningocele 4-Terminal myelocystocele * Without subcutaneous mass - Simple dysraphic states: 1-Intradural lipoma 2-Lipoma of filum terminale 3-Thickened filum terminale 4-Persistent ventriculus terminalis 5-Dermal sinus - Complex dysraphic states: 1-Neurenteric cyst 2-Diastematomyelia 3-Caudal agenesis Open dysraphism: not covered by intact skin 1-Myelocele 2-Myelomeningocele 3-Hemimyelocele 4-Hemimyelomeningocele